Steroid injection linked to increased risk of vertebral body fractures

Findings of a recently published retrospective study indicate that patients who undergo lumbar epidural steroid injections may be at increased risk for vertebral fractures.

“In the appropriate setting, and for the right patient, [lumbar epidural steroid injection] LESI provides effective symptomatic relief and improved level of function,” lead study author Shlomo Mandel, MD, MPH, from Henry Ford West Bloomfield Hospital in West Bloomfield, Michigan, stated in an American Academy of Orthopaedic Surgeons’ press release. “Through careful screening and monitoring steroid exposure, the risk of a fracture can be minimized. As orthopedic surgeons who specialize in spine, we know there is a role for injection therapy, but the challenge is to make sure it is administered safely and still provide long-term benefits.”

Shlomo Mandel

In the study, which appears in the Journal of Bone & Joint Surgery, Mandel and colleagues used ICD-9 codes to identify 50,345 patients with spine problems. From this group, they randomly selected 3,000 patients who underwent a LESI and compared them to 3,000 patients who did not undergo LESI. There were no significant differences between the groups regarding patient age, gender, corticosteroid use or hyperthyroidism, according to the study abstract.

Mandel and colleagues found each successive injection increased fracture risk by a factor of 1.21. “It’s important to remember that when contemplating an epidural steroid injection, a physician should have a symptomatic history, physical findings and corresponding imaging of direct pressure on a single nerve,” Mandel stated in the press release. “Together with our patient, we review the benefits and risks of alternative treatments before selecting an epidural steroid injection.”

References:

Shlomo S. J Bone Joint Surg Am. 2013;doi:10.2106/JBJS.L.00844.

www.aaos.org

Disclosure: Shlomo received funds from the Nancy and James Grosfield Foundation for his work on this study.